Page 219 - MHF-FeedingMinds-final.indd

210 7.3 Nutrition for Children with Chronic Diseases and Syndromes
The options available to increase energy and
nutrient intakes are:
●● more energy-dense foods and drinks so that
more energy is taken within the same volume of
food/drink
●● prescribable high-energy drinks or sip feeds to
supplement or replace oral intake
●● supplementary tube feeding by bolus during the
daytime or by pump during the day or overnight
●● 100 per cent of energy and nutrient requirements
via tube feeding.
Increasing the energy density of the
normal diet by adding extra
carbohydrate and/or fat
Advice needs to be tailored to foods normally eaten
and may include:
●● adding extra sugar or sweet syrups to breakfast
cereals, puddings, drinks and other sweet foods
●● stirring extra cream or powdered milk into milk
drinks and puddings
●● frying foods rather than grilling or baking them
●● adding extra oil or butter to vegetables, pasta,
rice, sauces and gravies
●● adding a prescribable supplement containing
carbohydrate and/or fat. These are much less
sweet than sugar and should not greatly alter the
taste of the food/drink. Suitable products include:
Maxijul, Polycal, Vitajoule (carbohydrate),
Calogen (fat) and Duocal (combined carbo–
hydrate and fat).
Prescribable high-energy drinks
or sip feeds
Several companies make a wide variety of these
prescribable products which are either milk-based
or juice-style drinks. A wide variety of flavours are
available and it is a matter of trial and error to find
which flavours each individual child will drink.
They come in a variety of sizes but usually
200–250 mL bottles or cartons for drinking. One
such drink per day may be adequate or a child may
need to try and drink two or three. When they are
drunk at the end of a meal or snack they are less
likely to reduce the appetite for normal foods.
As they are an expensive item for a GP’s budget,
care should be taken to review the prescription
frequently to make sure they are not being wasted
by being thrown away once a child has begun to
refuse them through taste boredom.
Tube feeding using prescribable
feeds
When children are not able to eat or drink as much
as they need to maintain a normal growth rate,
feeding via a tube may be recommended. Tube
feeding may provide:
●● some of their nutrient requirements to
supplement a limited oral intake
●● all their energy and nutrient requirements
where no oral intake is possible
●● specialized formulas for various disease states
that may be unpalatable to the child who refuses
to take them orally.
Tube feeding can be either continuous or bolus
feeding:
●● In continuous feeding the food is supplied over
a long period of time via a pump. The flow rate
can be adjusted. This is usual for overnight
feeding when a child is in bed. For daytime tube
feeding a child can wear a small back pack
containing a small portable pump. The child
can carry on with most daily activities while
being tube fed this way.
●● Bolus feeding can also use a pump or can be
administered using gravity for the feed to drain
down the tube.
Children who may need to be tube fed for some
time are those who:
●● are critically ill and require ventilation
●● have severe developmental delay
●● have malformations around the mouth
●● have faltering growth.